Provider Demographics
NPI:1164129094
Name:IRWIN SPECIALTY CENTERS LLC
Entity Type:Organization
Organization Name:IRWIN SPECIALTY CENTERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTANT
Authorized Official - Prefix:
Authorized Official - First Name:TAMI
Authorized Official - Middle Name:L
Authorized Official - Last Name:SANDIFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-468-3862
Mailing Address - Street 1:710 N IRWIN AVE
Mailing Address - Street 2:
Mailing Address - City:OCILLA
Mailing Address - State:GA
Mailing Address - Zip Code:31774-5011
Mailing Address - Country:US
Mailing Address - Phone:229-468-3800
Mailing Address - Fax:
Practice Address - Street 1:710 N IRWIN AVE
Practice Address - Street 2:
Practice Address - City:OCILLA
Practice Address - State:GA
Practice Address - Zip Code:31774-5011
Practice Address - Country:US
Practice Address - Phone:229-468-3800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-10
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center